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Call 866.588.2264 for Center for Spine Health
Call 800.392.3353 for Pain Management
BaCk Pain TreaTMenT Guide
Back Pain Treatment Guide
a reSourCe for PaTienTS
Eighty to 90 percent of people in the United States will suffer from
back pain at some time during their lives. Back pain is the second
most common reason people visit their family doctors. On any given
day, almost 2 percent of the entire United States workforce is dis-
abled by back pain. It is the cause of enormous healthcare expenses.
Each year, patients from around the world turn to Cleveland Clinic
for specialized treatment of spinal disorders. Some 16,000 adults
come to our Neurological Institute’s Center for Spine Health for relief
from common complaints such as low back pain and sciatica (leg
pain) as well as complex conditions such as spinal deformity, steno-
sis and tumor. In addition, our Anesthesiology Institute’s Department
of Pain Management, one of the nation’s largest and most experi-
enced, treats more than 10,000 new patients each year. The pain
management fellowship training program is the largest of its kind
in the country.
Specialists in both areas are dedicated to restoring function and
relieving your pain to the maximum extent possible. Whether your
goal is getting back to sports, work or hobbies, or just enjoying life,
Cleveland Clinic spine and pain management specialists can help.
using This GuidePlease refer to this guide as you examine
your treatment options. remember, it is your
right as a patient to ask questions and seek
a second opinion.
BaCk Pain TreaTMenT Guide2
WHaT are THe TYPeS of BaCk Pain?
The most common types are:
• acute back pain, a brief episode of pain that
comes on suddenly. Most acute back pain is due
to mechanical causes, such as a strain or sprain,
in which pain radiates from the spine and its
supporting structures. The pain may spread to the
buttocks, thighs or knees, and many sufferers
also experience spasms. Mechanical back pain is
generally more noticeable when flexing the back
or lifting heavy objects.
• Chronic, persistent back pain When back
pain persists beyond four to six weeks, further
medical evaluation is required. This pain is often
related to the spinal joints, discs or supporting
muscles of the back. In rare cases, cancer or
an infection is found.
When to See a Back Pain Specialist
Many back disorders can be evaluated and
treated successfully by a primary care doctor.
However, for severe or persistent pain, evaluation
by a medical spine or pain management specialist
is recommended. Warning signs that should
prompt urgent medical evaluation include the
presence of fever, worsening pain, progressive
movement of the pain from the back into the leg,
numbness in the area of the injury or down the
leg, presence of a lump or area with an unusual
shape, and pain that is unrelieved at rest or
disturbs sleep.
Call 866.588.2264 for Center for Spine Health
Call 800.392.3353 for Pain Management
3
WHaT are THe CauSeS of LoW BaCk Pain?
The back is a complex structure of bone and muscle, supported by
cartilage, tendons and ligaments and fed by a network of blood ves-
sels and nerves. The back—especially the lumbar, or lower, back—
bears much of the body’s weight during walking, running, lifting
and other activities. It makes sense, then, that injuries to the lower
back—such as strains and sprains—are common.
A common cause of low back pain is overstretched or injured mus-
cles that support the lower back. Muscles and connective tissues can
be injured from incorrectly lifting or carrying heavy objects. Muscles
in the back or abdominal muscles can also become weak from lack
of exercise. Engaging in sports that involve pushing and pulling—
such as weightlifting and football—may increase the risk of a low-
back injury. Other causes of low back pain include:
• Poor posture
• Standing or sitting in the same place for a long time
• Being significantly overweight
• Smoking
• “Slipped” disc, caused when a disc between vertebrae bulges past
the bones and presses against a nerve
• Osteoporosis (thinning of bone)
• Osteoarthritis, a breakdown of the tissues or bones of the joint
• Fibromyalgia, an illness that causes achy, tender muscles, among
other symptoms
• Trauma from injury due to an accident or fall that causes a
fracture or muscle strain
• Serious illnesses such as cancer or infection (this is rare)
Prevention is the most important management technique. Controlling
the factors you can control may help you avoid or recover quickly
from back problems.
Back Pain and Sciatica
Pain that affects primarily the back should
be distinguished from a spinal condition
that results mostly in leg pain, a disorder
commonly called sciatica. Typically, sciatica
is the result of a “pinched nerve” in the
spinal column. in most cases, the cause of
sciatica is clearly defined; for example, a disc
problem or arthritis. The cause of an episode
of back pain, on the other hand, often is more
difficult to pinpoint.
BaCk Pain TreaTMenT Guide4
diaGnoSinG BaCk Pain
A careful evaluation of your medical history and a physical
examination will help your healthcare provider determine the cause
of your back pain. He or she will then work with you to create an
appropriate treatment plan.
Your doctor may ask a series of questions to help identify possible
causes of the pain. These questions may focus on lifestyle factors,
when your pain began, where your pain is located, what effect
it has had on your daily activities, and whether your pain has
responded to any treatment. The doctor also will ask about your
medical, surgical, family and social history.
Mild strains and sprains can usually be diagnosed based on a
medical history—including a review of the method of injury and
the symptoms—and a physical exam. In cases of more severe
back pain, an X-ray may be taken to rule out a fracture or herni-
ated disc. If your symptoms or the examination suggest the pos-
sibility of infection, malignancy or a pinched nerve, additional tests
may be needed. However, X-rays, MRI/CT scans, EMGs and lab
tests are necessary in only a small number of cases.
The Mind-Body issue
The mind and body often work together
in shaping our experiences. Sometimes,
psychological factors can reduce or eliminate
the effects of physical problems. in most cases,
chronic back pain is a psychosomatic (“mind-
body”) condition in which a real physical
problem exists, but psychological factors play
a large role in determining the person’s
experience of that problem. in some cases,
mental processes such as dependence,
depression or frustration may make the pain
worse; in other cases, a positive attitude and
a sense of independence may lessen the pain.
Call 866.588.2264 for Center for Spine Health
Call 800.392.3353 for Pain Management
5
• Nerve blocks and injections
• Radiofrequency ablation
• Intradiscal ablation
• Tunneled epidural catheters for
continuous infusions
• Spinal cord stimulators
• Minimally invasive disc decompression
• Intraspinal drug pumps
• Osteopathic manipulation
• Acupuncture
Prudent Prescription advice
families, friends and neighbors are often a source
of advice on treating back pain. However, it is
important to realize that everyone is different and
it is never safe to take someone else’s medication.
always contact your healthcare provider before
taking any medication that is not prescribed
specifically for you.
TreaTinG BaCk Pain
Conservative Care
Many people diagnose their own back pain based on
experience, and treat the pain with over-the-counter medications
and rest. Fortunately, most back injuries will heal with this
conservative approach.
For patients who do not improve quickly, Cleveland Clinic
physicians will first explore nonsurgical treatment options for back
pain. For moderate-to-severe strains and sprains, the treatment
often occurs in two phases. The first phase, to reduce pain and
spasm, may involve rest and the use of ice packs and compres-
sion (pressure), especially for the first 24 to 48 hours following
an injury. An over-the-counter nonsteroidal anti-inflammatory
drug such as ibuprofen (Motrin®) may be recommended to help
reduce pain and swelling.
For the second phase, patients are encouraged to return to a
near-normal schedule to promote rapid recovery from back pain.
Most people experience a full recovery within two weeks. If
symptoms continue for more than two weeks, additional treat-
ments may be required.
interventional Treatments
For some patients, a prescription pain medication and physi-
cal therapy are enough to control the pain. Rapid healing can be
significantly enhanced through physical therapy, which focuses on
the structures that support the spine. It is important to work with
a spine-oriented physical therapist trained in an exercise approach.
Most exercise programs can be performed at home without special
equipment. The therapy will shorten recovery time and return you
to work and leisure activities as quickly as possible.
But for a small percentage of patients, back pain remains chronic,
persistent and disabling. For these people, more intensive treat-
ment may be needed. Cleveland Clinic specialists offer the latest
treatments and technologies for back pain, including:
BaCk Pain TreaTMenT Guide6
Surgical Treatment
For some patients, surgery may be the only possible solu-
tion to alleviate back pain. Although spinal surgery is often
delicate and complex, our surgeons have one of the highest
success rates in the country for even the most complicated
procedures. They also can offer the latest minimally invasive
techniques, when indicated, which result in less postoperative
pain and faster recovery.
In the hands of a skilled, experienced surgeon, the benefits
of surgical treatment usually far outweigh the risks. The most
common surgical conditions are degenerative spine conditions
such as disc herniation and spinal stenosis, followed by spinal
deformity such as scoliosis and kyphosis, fracture/trauma and
spine tumor. Whatever your diagnosis, our specialists apply
their knowledge and skill, combined with the latest techniques
and advanced technologies, to relieve your pain and restore
your function to the highest degree possible.
“When I woke up after the surgery, I realized
the pain was gone, and the pain is still gone.”
– Phyllis Hendricks, 78, who underwent
kyphoplasty after a fall left her with a
broken vertebra. Samuel Samuel, MD,
of Cleveland Clinic Pain Management
performed the procedure.
Spine Conditions Treated
at Cleveland Clinic
Cleveland Clinic has experts to treat these and
other back and neck conditions:
• degenerative back and neck disorders
• disc herniation
• Spinal deformities, including scoliosis
and kyphosis
• Spinal fracture
• Spinal stenosis
• Spinal tumor
• Spondylosis/spondylolisthesis
• Chiari malformation
Call 866.588.2264 for Center for Spine Health
Call 800.392.3353 for Pain Management
7
“The next day, I felt the best I had in four years.”
– David Marshall Jr., OD, PhD, a Center for
Spine Health patient, noting that his spinal stenosis
surgery relieved him of much of the pain associated
with reflex sympathetic dystrophy (RSD), a
progressive nerve disorder that can lead to
crippling and permanent damage.
keePinG Your BaCk HeaLTHY
It is not possible to prevent all back injuries, but you
can take some simple steps to help lower the risk of a
sprain or strain. Here are some “back-saving” tips:
• Eat a healthy, well-balanced diet to keep your
bones and muscles strong.
• Maintain a healthy weight. Excess weight puts
added stress on the structures of the lower back.
• Exercise regularly, including stretching, to keep
your joints flexible and your back and abdominal
muscles strong.
• Choose activities and sports, such as swimming
and biking, that do not place your lower back at
risk of injury.
• Use good body mechanics when sitting, standing
and lifting. Try to keep your back straight and your
shoulders back. When sitting, keep your knees
bent and your feet flat on the floor. Don’t over-
reach, and avoid twisting movements. When
lifting, bend your knees and use your strong leg
muscles to help balance the load.
• Maintain good posture. If you start to feel sore
or stiff, change your posture and modify your body
mechanics. Your body will warn you, using pain
as a signal, when your mechanics are improperly
aligned.
• Practice safety measures to help prevent falls,
such as wearing shoes that fit properly and
keeping stairs and walkways free of clutter.
• Don’t smoke. Nicotine interferes with blood flow
to the muscles.
BaCk Pain TreaTMenT Guide8
LiVinG WiTH BaCk Pain
In some circumstances, back pain will persist and the individual
will need to learn to manage it long term. The Chronic Pain Re-
habilitation Program is an intensive, three- to four-week treatment
and education program that targets patients who are devastated
by their pain. The program’s services include physical and occupa-
tional therapy, coping skills training, medication management and
psychotherapy to reduce negative emotions that result from and
worsen pain.
Patients may be referred to the program by a physician, though a
referral is not necessary. For appointments and more information,
call 216.636.5860 or toll free, 866.588.2264.
Here are some tips for living with persistent, chronic back pain:
• Medical compliance If patients are to live with their pain long
term, it is important that they take their medication as prescribed.
By relieving pain symptoms, medications can facilitate an active,
exercise-oriented rehabilitation program.
• Physical conditioning This is particularly important for chronic
pain patients. Carrying excess weight, smoking tobacco and
drinking alcohol will exacerbate chronic pain. Active, exercise-
oriented physical therapy is the cornerstone of treatment.
• Stress reduction Stress makes pain worse. Not all stress
is avoidable, but reducing or eliminating sources of persistent
stress, where possible, will help in reducing the overall
experience of pain.
• interpersonal support It is natural for others to become
frustrated with a person’s chronic pain and complaints. The
patient needs to make a special effort to foster and maintain
social support.
• activities One of the best strategies for living with chronic
pain is distraction. It is important for self-esteem to maintain
some work role if possible, establish a clear role in the family,
take on regular interpersonal duties, and maintain hobbies or
personal interests.
• Pain reduction techniques Psychological approaches such
as yoga, biofeedback and self-hypnosis are helpful in reducing
chronic pain.
Call 866.588.2264 for Center for Spine Health
Call 800.392.3353 for Pain Management
9
CLeVeLand CLiniC CenTer for SPine HeaLTH
The Center for Spine Health’s multidisciplinary team brings together
the expertise of nationally recognized Cleveland Clinic specialists
in orthopaedic surgery, neurosurgery and medical spine, offering
patients with back and neck pain the latest, most innovative and
effective medical and surgical treatments.
The Center for Spine Health integrates research, clinical practice
and education, with the goals of improving patient care, develop-
ing unique technologies and subspecializations, and promoting
cross-fertilization of ideas among staff.
From periodic monitoring to intensive surgical correction, we
provide state-of-the-art management for back and spine problems.
Among the many therapeutic options we offer are:
• Spine surgery
• Mature spine care
• Spine wellness
• Spine injury prevention
• Interventional spine therapies
• Rehabilitation and physical therapy
The Center for Spine Health is located on the main Cleveland
Clinic campus and at Lutheran Hospital. Many of our specialists
also see patients at Cleveland Clinic family health centers, which
are conveniently located throughout northeast Ohio.
If you require surgery, it will be performed at the Cleveland Clinic
main campus or Lutheran Hospital. (In some cases, there is
an option for surgery at Hillcrest Hospital). You may be able to
schedule your pre- and postoperative appointments at one of our
convenient community locations (see page 11 and back cover).
To make an appointment with a Cleveland
Clinic Center for Spine Health specialist, call
216.636.5860 or toll-free 866.588.2264,
or visit clevelandclinic.org/spine for further
information.
BaCk Pain TreaTMenT Guide10
To make an appointment with a
Cleveland Clinic Pain Management
specialist, call 216.444.Pain (7246) or
toll-free 800.392.3353, or visit
clevelandclinic.org/painmanagement
for further information.
CLeVeLand CLiniC deParTMenT of Pain ManaGeMenT
When chronic back pain disrupts your quality of life and does not
improve with standard treatments such as aspirin and ibuprofen,
Cleveland Clinic’s Department of Pain Management is here to help.
Many safe, proven, effective treatments are available to eliminate
or reduce chronic back pain. The sooner you seek treatment, the
sooner you can start enjoying life again.
Our board-certified physicians are dedicated to the goal of helping
people with chronic pain return to a normal, productive lifestyle.
Using the latest in diagnostic technology, paired with medical and
interventional therapeutics, they will work with you to identify the
source of your back pain, eliminate or reduce the pain, and teach
you to manage it.
Among the conditions our specialists treat are:
• Back and neck pain, including herniated discs,
spinal stenosis, tumors and arthritis
• Chronic abdominal pain and pelvic pain
• Complex regional pain syndrome (also known
as reflex sympathetic dystrophy or RSD)
• Muscle and joint pain
• Headache
• Sports injuries
• Disorders of the nervous system, including
shingles and trigeminal and occipital neuralgia
(facial pain)
• Pain associated with AIDS
• Sickle cell anemia
• Cancer pain
• Intractable spasticity associated with multiple
sclerosis or spinal cord injury
• Pain associated with osteoporosis and vertebral
compression fractures
Our staff is acclaimed for its research and education
in pain management. Patients who qualify have the
opportunity to participate in clinical trials seeking bet-
ter, more effective treatments for managing pain. Our
physicians regularly publish in leading medical jour-
nals and are invited lecturers at medical education
seminars across the country and around the world.
Multidisciplinary teams of pain management physi-
cians, nurses, psychologists and therapists work
together to treat patients at 22 locations throughout
Ashtabula, Cuyahoga, Geauga, Lake, Lorain, Medina
and Summit counties (see page 11 and back cover).
Call 866.588.2264 for Center for Spine Health
Call 800.392.3353 for Pain Management
11
Cleveland Clinic Main Campus
9500 Euclid Ave./C25 Cleveland, OH 44195 216.444.PAIN (7246) 800.392.3353
ashtabula County Medical Center
2420 Lake Ave. Ashtabula, OH 44004 440.997.6700
avon Lake family Health Center
450 Avon Belden Road Avon Lake, OH 44012 440.930.6800
Beachwood family Health and Surgery Center
26900 Cedar Road Beachwood, OH 44122 216.839.3000
Broadview Heights Pain Management Center
2001 E. Royalton Road Broadview Heights, OH 44147 216.587.8830
Brunswick family Health Center
3574 Center Road Brunswick, OH 44212 330.225.8886
Chagrin falls family Health Center 551 E. Washington St. Chagrin Falls, OH 44022 440.893.9393
elyria family Health and Surgery Center
303 Chestnut Commons Drive Elyria, OH 44035 440.366.9444
Cleveland Clinic Main Campus
9500 Euclid Ave./S7 Cleveland, OH 44195 216.636.5860 866.588.2264
Broadview Heights family Health Center
2001 E. Royalton Road Broadview Heights, OH 44147 216.636.5860
Hillcrest Hospital
6780 Mayfield RoadMayfield Heights, OH 44124 216.636.5860
Lutheran Hospital
1730 W. 25th St.Cleveland, OH 44113 216.636.5860
Solon family Health Center
29800 Bainbridge Road Solon, OH 44139 216.636.5860
Strongsville family Health and Surgery Center
16761 SouthPark CenterStrongsville, OH 44136 216.636.5860
Westlake family Health Center
30033 Clemens Road Westlake, OH 44145 216.636.5860
Willoughby Hills family Health Center
2570 SOM Center Road Willoughby Hills, OH 44094 216.636.5860
euclid Hospital
18901 Lake Shore Blvd. Euclid, OH 44119 216.692.7543
fairview Hospital
18099 Lorain Ave., Suite 404Cleveland, OH 44111 216.476.7331
Hillcrest Hospital
6803 Mayfield Road, Suite 200 Mayfield Heights, OH 44124 440.312.7246
Lakewood Hospital
14601 Detroit Ave., Suite 260 Lakewood, OH 44107 216.529.7246
Lorain family Health and Surgery Center
5700 Cooper Foster Park RoadLorain, OH 44053 440.204.7400
Lutheran Hospital
1730 W. 25th St., Suite 4A Cleveland, OH 44113 216.363.2391
Marymount Hospital
12300 McCracken Road, Suite 259 Garfield Heights, OH 44125 216.587.8830
Medina Hospital
1000 E. Washington St. Medina, OH 44256 330.225.8886
Solon family Health Center
29800 Bainbridge Road Solon, OH 44139 440.519.6925
Cleveland Clinic Center for Spine Health Locations
Cleveland Clinic Pain Management Locations
South Pointe Hospital
20000 Harvard Road, Building A Warrensville Heights, OH 44122 216.491.6433
Strongsville family Health and Surgery Center
16761 SouthPark Center Strongsville, OH 44136 440.878.2500
Twinsburg Pain Management Center
2365 Edison Blvd., Suite 100 Twinsburg, OH 44087 330.888.4000
Westlake Pain Management Center
850 Columbia Road, Suite 120 Westlake, OH 44145 440.835.8233
Willoughby Hills family Health Center
2570 SOM Center Road Willoughby Hills, OH 44094 440.943.2500
Call 866.588.2264 for Center for Spine Health
Call 800.392.3353 for Pain Management
BaCk Pain TreaTMenT Guide
Broadview HeightsFamily Health Center
Strongsville Family Health & Surgery Center
Brunswick Family Health Center
Medina Hospital
Hillcrest Hospital
LutheranHospital
Solon Family Health Center
Westlake FamilyHealth Center
Willoughby HillsFamily Health Center
Ashtabula CountyMedical Center
Avon LakeFamily
Health Center
Beachwood FamilyHealth & Surgery Center
Broadview HeightsPain Management Center
Chagrin Falls Family Health Center
Elyria Family Health & Surgery Center
EuclidHospital
Fairview Hospital
LakewoodHospital
Lorain Family Health & Surgery Center
MarymountHospital
South Pointe Hospital
Twinsburg Pain Management Center
Westlake PainManagement Center
Cleveland Clinic Center for Spine Health Locations
Cleveland Clinic Pain Management Locations
our reGionaL SYSTeM